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CHAPTER I

MAJOR AND MINOR EPILEPSY

(Grand and Petit Mal)

"My son is sore vexed, for ofttimes he falleth into the fire, and ofttimes into the water." - Matthew xvii, 15.

"Oft, too, some wretch before our startled sight,

Struck as with lightning with some keen disease,

Drops sudden: By the dread attack o'erpowered

He foams, he groans, he trembles, and he faints;

Now rigid, now convuls'd, his labouring lungs

Heave quick, and quivers each exhausted limb.

* * * * *

"He raves, since Soul and Spirit are alike

Disturbed throughout, and severed each from each

As urged above, distracted by the bane;

But when at length the morbid cause declines,

And the fermenting humours from the heart

Flow back - with staggering foot first treads

Led gradual on to intellect and strength." - Lucretius.

Epilepsy, or "Falling Sickness", is a chronic abnormality of the nervous system, evinced by attacks of alteration of consciousness, usually accompanied by convulsions.

It attacks people of every race, as well as certain domesticated animals, and has been known since the earliest times. The ancients assumed it to be caused by demons, the anger of the gods, a blow from a star, or another "otherworldly" source.

It often attacks men in crowds, when excited by [pg 2] oratory or sport, hence the Roman name: morbus comitialis (crowd sickness).

In mediæval times, sufferers were regarded with awe, as being possessed by a spirit. Witch doctors among savages, and founders and expounders of differing creeds among more civilized peoples, have taken advantage of this infirmity to claim divine inspiration, and the power of "seeing visions" and prophesying.

Epilepsy has always interested medical men because of its frequency, the difficulty of tracing its cause, and its obstinacy to treatment, while it has appealed to popular imagination by the appalling picture of bodily overthrow it presents, so that many gross superstitions have grown up around it.

The description in Mark ix. 17-29, is interesting:

"Master, I have brought Thee my son, which hath a dumb spirit. And wheresoever he taketh him, he teareth him: and he foameth, and gnasheth with his teeth, and pineth away: ... straightway the spirit tare him; and he fell on the ground, and wallowed foaming.

"And He asked his father, How long is it ago since this came unto him? And he said, Of a child. And ofttimes it hath cast him into the fire, and into the waters, to destroy him.

"And he said unto them, This kind can come forth by nothing, but by prayer and fasting."

Up to the present, epilepsy can be ascribed to no specific disease of the brain, the symptoms being due to some morbid disturbance in its action. Epilepsy is a "functional" disease.

GRAND MAL ("Great Evil")

An unusual feeling called an aura (Latin - vapour), sometimes warns a patient of an impending fit, [pg 3] commonly lasting long enough to permit him to sit or lie down. This is followed by giddiness, a roaring in the ears, or some unusual sensation, and merciful unconsciousness. In many cases this stage is instantaneous; in others it lasts some seconds - but an eternity to the sufferer. This stage is all that victims can recall (and this only after painful effort) of an attack.

As unconsciousness supervenes, the patient becomes pale, and gives a cry, which varies from a low moan to a loud, inhuman shriek. The head and eyes turn to one side, or up or down, the pupils of the eyes enlarge and become fixed in a set stare, and the patient drops as if shot, making no effort to guard his fall, being often slightly and sometimes severely injured.

The whole body then becomes stiff. The hands are clenched, with thumbs inside the palms, the legs are extended, the arms stiffly bent, and the head thrown back, or twisted to one side. The muscles of the chest and heart are impeded in their action, breathing ceases, the heart is slowed, and the face becomes pale, and then a livid, dusky blue.

The skin is cold and clammy, the eyebrows knit; the tongue may be protruded, and bitten between the teeth. The eyeballs seem starting from their sockets, the eyes are fixed or turned up, so that only the sclerotic ("whites") can be seen, and they may be touched or pressed without causing blinking. The stomach, bladder, and bowels may involuntarily be emptied.

This tonic stage only lasts a few seconds, and is followed by convulsions. The head turns from side to side, the jaws snap, the eyes roll, saliva and blood mingle as foam on the lips, the face is contorted in frightful grimaces, the arms and legs are twisted and jerked about, the breathing is deep and irregular, the whole body writhes violently, and is bathed in sweat.

[pg 4]

The spasms become gradually less severe, and finally cease. Deep breathing continues for some seconds; then the victim becomes semi-conscious, looks around bewildered, and sinks into coma or deep sleep.

"...As one that falls,

He knows not how, by force demoniac dragg'd

To earth, and through obstruction fettering up

In chains invisible the powers of Man;

Who, risen from his trance, gazeth around

Bewilder'd with the monstrous agony

He hath indured, and, wildly staring, sighs:

..."

In a few hours he wakes, with headache and mental confusion, not knowing he has been ill until told, and having no recollection of events just preceding the seizure, until reminded of them when they are slowly, and with painful effort, brought to mind. He is exhausted, and often vomits. In severe cases he may be deaf, dumb, blind, or paralysed for some hours, while purple spots (the result of internal hemorrhage) may appear on the head and neck. Victims often pass large quantities of colourless urine after an attack, and, as a rule, are quite well again within twenty-four hours.

This is the usual type, but seizures vary in different patients, and in the same sufferer at different times. The cry and the biting of the tongue may be absent, the first spasm brief, and the convulsions mild. Epilepsy of all kinds is characterized by an alteration (not necessarily a loss) of consciousness, followed by loss of memory for events that occurred during the time that alteration of consciousness lasted.

Attacks may occur by day only, by day and by night, or by night only, though in so-called nocturnal epilepsy, it is sleep and not night that induces the fit, for night-workers have fits when they go to sleep during the day.

[pg 5]

Victims of nocturnal epilepsy may not be awakened by the seizure, but pass into deeper sleep. Intermittent wetting of the bed, occasional temporary mental stupor in the morning, irritability, temporary but well-marked lapses of memory, sleep-walking, and causeless outbursts of ungovernable temper all suggest nocturnal epilepsy.

Such a victim awakes confused, but imputes his mental sluggishness to a hearty supper or "a bad night". A swollen tongue, blood-stained pillow, and urinated bed arouse suspicion as to the real cause, suspicion which is confirmed by a seizure during the day. He is more fortunate (if such a term can rightly be used of any sufferer from this malady) than his fellow victim whose attacks occur during the day, often under circumstances which, to a sensitive nature, are very mortifying.

Epileptic attacks are of every degree of violence, varying from a moment's unconsciousness, from which the patient recovers so quickly that he cannot be convinced he has been ill, to that awful state which terrifies every beholder, and seems to menace the hapless victim with instant death. Every degree of frequency, too, is known, from one attack in a lifetime, down through one in a year, a month, a week, or a day; several in the same periods, to hundreds in four-and-twenty hours.

PETIT MAL ("Little Evil")

This is incomplete grand mal, the starting stages only of a fit, recovery occurring before convulsions.

Petit mal often occurs in people who do not suffer from grand mal, the symptoms consisting of a loss of consciousness for a few seconds, the seizure being so brief that the victim never realizes he has been unconscious. [pg 6] He suddenly stops what he is doing, turns pale, and his eyes become fixed in a glassy stare. He may give a slight jerk, sway, and make some slight sound, smack his lips, try to speak, or moan. He recovers with a start, and is confused, the attack usually being over ere he has had time to fall.

If talking when attacked, he hesitates, stares in an absent-minded manner, and then completes his interrupted sentence, unaware that he has acted strangely. Whatever act he is engaged in is interrupted for a second or two, and then resumed.

A mild type of petit mal consists of a temporary blurring of consciousness, with muscular weakness. The victim drops what he is holding, and is conscious of a strange, extremely unpleasant sensation, a sensation which he is usually quite unable to describe to anyone else. The view in front is clear, he understands what it is - a house here, a tree there, and so on - yet he does not grasp the vista as usual. Other victims have short spells of giddiness, while some are unable to realize "where they are" for a few moments.

Frequent petit mal impairs the intellect more than grand mal, for convulsions calm the patient as a good cry calms hysterical people. After a number of attacks of petit mal, grand mal usually supervenes, and most epileptics suffer from attacks of both types. Some precocious, perverse children are victims of unrecognized petit mal, and when pushed at school run grave risks of developing symptoms of true epilepsy. The "Little Evil" is a serious complaint.